Instillation of 10 drops, two or three times daily. of a mixture of dilute hydro chloric acid, 10 drops, with 1 fluidounce of pyrozone found to effect a cure of chronic suppuration of the middle ear, even in attic complication, in a short time. W. Cheatham (Med. Record, Sept. 12. '9(3).
The disease being limited to the atrium and the perforation being gen erous, local antiseptics will often effect a cure. The surgeon must persevere for months and even years with such ment, if he observes that the tendency of the purulency is to lessen, and the condition of the diseased mucous mem brane of the drum-space improves. If the purulency ceases under local septics, the hearing may be found to be lcss after the discharge ceases than while it prevailed. This is due to the fact that in the healing process the partially-de stroyed ossicles and membrana tympani have been bound together against the promontory and oval window, by chite, and sound-conduction thus im ppded. When the largest ossicles are stroyed by necrosis or removed by the surg.eon, healing of the chronic puru lency of the drum-cavity ensues with out synechial interference to the con duction of sound to the oval window, and the hearing is better in such cases than when healing occurs with the ossi cles or their remnants in position. If, after six months or sooner, the tendency of the chronic purulency of the middle ear is not toward improvement under the above-named local antisepsis, it is be cause drainage is defective; antiseptics cannot reach the entrenched staphylo cocci, and caries and necrosis of the ossicles and, sometimes, of the neighbor ing tympanic walls, are advancing. This is especially true in chronic purulency of the attic. Such a patient is threat ened now with deeper and most serious lesions in the antrum and mastoid cavi ties, involving the petrous bone on its inner surfaces, in the middle and poste rior cranial fossm. For a consideration of these profound and threatening lesions the reader is referred elsewhere. (See CEREBRAL ABscEss and ENCEPHALITIS, volume ii.) In 14,5S0 autopsies 4S cases were found in which death resulted from cerebral disease secondary to purulent otitis media. Of 17 abscesses, 12 were in the temporal lobe. 4 in the cerebellum, and 1 in both cerebellum and occipital lobe.
In 16 cases there was thrombosis of the sinus. Brain-abscess is found almost exclusively in chronic purulent otitis. Poulsen (111iinch. med. Woch., No. 24, '96).
Septic infection may pass from the tympanic cavity and mastoid antrum through the labyrinthine spaces and auditory and facial nerves to the cere bellar cavity. Thomas Barr (Arch. of Otol., July, '97).
Chronic purulent otitis media having defied local antiseptic treatment for rnonths, and the ossicles or the petrous bone in their vicinity being carious, the only indication is to remove the ossicles and thus favor drainage from the drum cavity and better local treatment of its purulent walls by means of antiseptics. Some advise immediate resort to a mas toid trepanation and deeper surgical measures applied to the petrous bone, for the cure of chronic purulency that has defied for a year antiseptic treatment, without resort to ossiculectomy and fur ther antiseptic treatment. But, in the absence of urgent and threatening mas toid and intracranial symptoms, mastoid trepanation is unjustifiable simply for the cure of chronic purulency. Indeed, in the absence of urgent cranial symp toms, removal of polypi, ossiculectomy, and excision of the remnants of the membrane followed by the application of antiseptics will usually effect a cure of the tympanic purulency, in time, but in any case the condition of the inflamed middle ear is rendered better, thus pre venting symptoms demanding a mastoid trepanation in any of its forms.
S cases of the radical, or Stacke, operation on chronically suppurating middle-ear cavities good results were ob tained notwithstanding the dosing of the retro-auricular opening. Urbantschitsch (Aust. Otol. Soc., June, '96; Jour. Laryn., Rhin., and Otol., Oct., '96).
In 53 cases of chronic suppuration of the middle ear, middle-ear cavities ex posed by surgical operation. In 17 in stances the suppuration stopped at once; 6 patients died,-3 from pyremia exist ing before the operation, 2 from chronic tuberculosis, and 1 from cerebral abscess existing before the operation on the ear. The remainder of the 53 cases continued under observation. A. Politzer (Aust. Otol. Soc., ,Tune, '96; Ann. des Mal. de l'Or., Jan., '97).